Basilar artery occlusion following C1 lateral mass fracture managed by mechanical and pharmacological thrombolysis.
BACKGROUND
Vertebral artery injury following cervical spine trauma can be associated with stroke. We present a case of a C1 fracture resulting in vertebral artery dissection and neurological decline as a result of basilar artery occlusion treated with chemical and mechanical thrombolysis resulting in basilar artery patency and clinical improvement.


METHODS
The patient is a 43-year-old female who was involved in a motor vehicle collision where she sustained multiple cervical spine injuries including a comminuted fracture of the left lateral mass of C1 resulting in vertebral artery dissection which eventually led to a basilar artery embolus and occlusion. A total of 15 mg of intraarterial tissue plasminogen activator was infused throughout the clot, followed by mechanical clot embolectomy using an FDA-approved device. Her neurological exam improved post-procedurally and she was discharged with a left hemiparesis to a rehabilitation facility 3 weeks after admission. At 15 month follow up, she is neurologically intact with the exception of some subtle difficulty with fine motor movement in the right upper extremity and mild dysmetria on the right.


CONCLUSIONS
With this case, we report a rare and potentially devastating complication of C1 fracture. To our knowledge there are only two previously reported cases where a C1 fracture has been associated with basilar artery occlusion resulting in death and locked-in syndrome respectively. In this case, chemical thrombolysis and mechanical thrombectomy resulted in recanalization of the basilar artery with excellent long-term neurological outcome.
Sugrue
Patrick A
PA
Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 N. St. Clair, Suite 2210, Chicago, IL 60611, USA.
Hage
Ziad A
ZA
Surdell
Daniel L
DL
Foroohar
Mina
M
Liu
John
J
Bendok
Bernard R
BR
D000063:Accidents, Traffic; D000328:Adult; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000473:pathology; D005260:Female; D006801:Humans; D010291:Paresis / Q000209:etiology; D016103:Spinal Fractures / Q000209:etiology* / Q000473:pathology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*
D010959:Tissue Plasminogen Activator